title: [Is the court-ordered treatment indication by the expert based on a medical diagnosis?].
abstract: Court-ordered treatment was created in 1998, as part of a law against sexual offense recidivism. The creation of court-ordered treatment is based on the premise that many offenders have psychiatric disorders. If the court-ordered treatment is appraised as an effective way to prevent recidivism by the lawmaker, the preeminent role of psychiatry, in the prevention of recidivism has generated controversy in the psychiatric community. Few studies have been conducted on court-ordered treatment in France, and have concerned epidemiological measures. Court-ordered treatment leads to an extension of the expert's mission. In order to prevent recidivism, the interest of a treatment is a new part of the expert's mission.
  
  
  OBJECTIVE
  The main purpose of this study was to assess the kind of diagnosis reported by the forensic psychiatrist who considered the court-ordered treatment as appropriate.
  
  
  METHODS
  We led a descriptive and retrospective study among the experts' reports of 68 subjects followed by three psychiatrists. We categorized each diagnosis found in the experts' reports in reference to DSM-IV-TR axis I and axis II. As the expert has no obligation to refer to the DSM-IV-TR, we also considered the "no DSM-IV-TR categorized disorder" as a category. The primary outcome was the proportion of each diagnosis category in experts' reports, in which the forensic psychiatrist agreed with the indication of a court-ordered treatment.
  
  
  RESULTS
  We analysed 123 experts' reports in which the mission was to diagnose a mental disorder and to assess the need for a court-ordered treatment. The expert agreed with the need for a court-ordered treatment in 112 reports. In those reports the diagnosis was "no disorder" in 27% of them, "no DSM-IV-TR categorized disorder" in 26% of them, "axis II disorder" in 24% of them, "axis I disorder" in 19% of them, and "association of an axis I and an axis II disorder" in 4% of them.
  
  
  CONCLUSIONS
  The diagnoses were heterogeneous. Their associations with the need for a court-ordered treatment seem to be contradictory when considering the association between "no mental disorder" and "need for a court-ordered treatment" found in 27% of the reports. These paradoxical results led us to question the meaning of mental disorder and treatment.
authors.affiliation: Service de médecine légale, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France. Electronic address: helene.spriet35@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Spriet
authors.affiliation: Service de médecine légale, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
authors.forename: M
authors.initials: M
authors.lastname: Abondo
authors.affiliation: Service de pharmacologie clinique, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
authors.forename: F
authors.initials: F
authors.lastname: Naudet
authors.affiliation: Service de médecine légale, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
authors.forename: R
authors.initials: R
authors.lastname: Bouvet
authors.affiliation: Service de médecine légale, université de Rennes 1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 09, France.
authors.forename: M
authors.initials: M
authors.lastname: Le Gueut
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D002650:Child Abuse, Sexual / Q000331:legislation & jurisprudence / Q000523:psychology; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D011329:Prisoners / Q000331:legislation & jurisprudence / Q000523:psychology; D012189:Retrospective Studies; D012742:Sex Offenses / Q000331:legislation & jurisprudence / Q000523:psychology
keywords: Criminal law; Expert testimony; Expertise psychiatrique pénale; Forensic psychiatry; Injonction de soins; Mental disorders; Psychiatrie légale; Trouble mental